Active NPI
Varicose Vein Medical Office PC
- Phlebology Physician
- Port Jefferson, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebology Physician
- License
- 174810
- Legal business name
- VARICOSE VEIN MEDICAL OFFICE PC
- Practice address
- 405 E Main St
Port Jefferson, NY 11777-1868 - Phone
- (631) 474-1414
- Fax
- (631) 474-2032
- NPI assigned
- Nov 30, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jerry Ninia, MD
- Title
- Owner
- Phone
- (631) 474-1414
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebology Physician | 202K00000X | 174810 | NY | Primary |
Addresses
Primary practice location
405 E Main St
Port Jefferson, NY 11777-1868
Mailing address
405 E Main St
Port Jefferson, NY 11777-1868
Phone (631) 474-1414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Phlebology Physician
- Port Jefferson, NY
- NPI 1174753875
O20150710000658
National Provider Directory
National Provider Directory- Tax ID family
- Varicose Vein Medical Office PC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Phlebology Physician
- Port Jefferson, NY
- NPI 1174753875
Locations
405 E Main St
Prt Jefferson, NY 11777
Phone (631) 474-1414
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Port Jefferson Station, NY
- NPI 1457350795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322611200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1322611200000",
"number": "1356618615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 E MAIN ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771868",
"telephone_number": "631-474-1414",
"fax_number": "631-474-2032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 E MAIN ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771868",
"telephone_number": "631-474-1414",
"fax_number": "631-474-2032"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VARICOSE VEIN MEDICAL OFFICE PC",
"organizational_subpart": "NO",
"enumeration_date": "2011-11-30",
"last_updated": "2011-11-30",
"status": "A",
"authorized_official_last_name": "NINIA",
"authorized_official_first_name": "JERRY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "631-474-1414",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "202K00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Phlebology",
"state": "NY",
"license": "174810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.